State officials estimate that up to 2,000,000 people, including approximately 180,000 people experiencing homelessness, could lose Medi‑Cal coverage under new Medicaid eligibility rules implemented by the Trump administration. Advocates warn this may shrink street medicine teams, increase reliance on emergency rooms, and jeopardize housing and services tied to Medi‑Cal.
Starting in 2027, the federal work‑requirement law requires states to verify 80 monthly work hours for able‑bodied adults younger than 65 without dependent children and renew eligibility every six months. This creates a challenge for people experiencing homelessness, who often lack resources to apply for jobs in an increasingly digital workforce and maintain employment without regular access to showers.
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The new regulations create exemptions for children, people who are pregnant, youth in foster care and people with disabilities.
State Medi-Cal officials are building an automated verification system to check work compliance and exemptions, hoping to spare 3.5 million Californians from paperwork under 2027 rules. Linking IRS data, purchased workforce data, state universities and colleges and medical diagnosis codes will auto-detect exemptions. However, gaps will still remain since volunteer work isn’t in databases, including work carried out by street teams that provide free care outside of a clinical setting.
